Septal Reposition during Intermediate Cleft Rhinoplasty: A Second Chance for Correcting Caudal Septal Deviation

Overview

Children born with a cleft lip often need a second nasal correction before school age. The authors asked whether adding septal repositioning to the standard alar cartilage suspension improves the result. They retrospectively reviewed 77 patients aged 5 to 6, split by treatment era, and compared standardized photographs.

Sections of note

• Design: retrospective photogrammetric comparison of two time based groups. Level of evidence therapeutic III.
• Septal repositioning group: 43 patients treated 2015 to 2017. Control group: 34 patients treated 2009 to 2015. All had alar cartilage suspension; the groups differed by whether septal repositioning was added.
• Measurements were cleft side to noncleft side ratios for nostril width, nostril height, nostril area and the caudal septal deviation angle.
• Assessment ages: 5.32 years before surgery, 6.57 at short term follow up, 9.28 at long term follow up.
• The septal repositioning group showed significantly improved nostril width ratio and caudal septal deviation angle at both follow up points.
• It also decreased the nostril area ratio at both points, through a smaller cleft side area and a larger noncleft side area.

What it means for a patient

• Adding septal work at the preschool operation is presented as a second chance to straighten a septum the first repair did not fully correct.
• Nostril width and septal angle improved, but the nostril area ratio fell partly because the noncleft nostril enlarged.
• Follow up extended to about age nine, before the growth spurt, so the effect at facial maturity is not shown.
• Limits: retrospective, groups defined by treatment era rather than randomization, so surgical experience also changed between them.

Why this paper matters

Cleft nasal correction is staged across childhood, and each stage is a chance to address deviation before growth locks it in. Showing that septal repositioning at age five to six holds for several years supports adding it. Whether it reduces the need for definitive rhinoplasty at maturity is unanswered.

Terms

• Cleft lip nose: the characteristic nasal asymmetry accompanying a cleft lip.
• Intermediate rhinoplasty: a corrective nose operation during childhood.
• Caudal septum: the front lower edge of the wall dividing the two sides of the nose.
• Alar cartilage suspension: lifting and anchoring the lower tip cartilage on the cleft side.
• Photogrammetric comparison: measurement of distances and angles from photographs.